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Grade one students wear masks as they attend class at Honore Mercier elementary school in Montreal on March 9.Ryan Remiorz/The Canadian Press

Katharine Smart is the president-elect of the Canadian Medical Association.

In a little more than two weeks, children from coast-to-coast-to-coast will start their new school year, loaded down with school supplies and looking to reconnect with friends. As a mother, I know the importance of this milestone for children and families. But as a pediatrician, I can’t help but worry about the current pandemic projections and how our children will again bear the consequences of our leaders’ decisions.

The combination of the rapid rise of Delta variant-related cases of COVID-19 and the return to school for hundreds of thousands of unvaccinated children could yield our most challenging wave yet. Not only are thousands of children under 12 unvaccinated, but many who have been tasked to care for our children have chosen to remain unprotected, making themselves a transmission threat.

I have it heard it all before: that children are not as affected by COVID-19 as those with co-morbidities, that children can wear masks, that children will recover much more quickly, that children should not be subjected to vaccine experiments, that children will not die.

But these justifications are inadequate, and mortality is a crude outcome measure in pediatrics. What about the impact of disability, of potential trauma during medical care, on families and on mental health?

As a pediatrician, I’ve had the opportunity to work in children’s hospitals, on Medevac teams and now in the Yukon. As we see case numbers surge as a result of the rapid spread of the Delta variant, I believe this new wave could become an incredible foe and test the limits of our health care system. But what’s baffling to me is that we seem to be approaching the inevitable like we don’t know the consequences. We have now experienced this pandemic in three waves – so why have we not yet applied the lessons learned? Why are we so determined to play the waiting game when we know it will only leave us to play catch-up afterwards?

It is clear this fourth wave of COVID-19 will be the result of misinformation, under-vaccination and premature abandonment of public health mitigation strategies. With the virus still very present in our communities, why are we relaxing mask mandates? With the knowledge that the virus is airborne, why are we not addressing school ventilation urgently? With just weeks left before the school year starts across the country, why are we not mandating everyone who poses a risk to our children to get vaccinated or at least tested? The effectiveness of asking nicely or encouraging people to do the right thing has plateaued – now, the health of our children is on the line.

Critical care for children is limited – often, it’s only available in major urban centres – and many providers are already maxed out. Medevac operations are complex and resources are limited. I have personally spent many long nights waiting bedside to move a critically ill child from the north to a pediatric ICU in a city. What makes us think this will get any easier?

As we look ahead at the next two weeks, we have solutions that we could apply, right now, to help us avoid the worst-case scenario. We need to increase the number of fully vaccinated Canadians with all the levers available and the lessons we’ve learned. Let’s reinstate or keep in place mandatory masks indoors, and get the ventilation inside schools done properly. Nothing should be off the table.

When it comes to this pandemic, let’s remind ourselves how dangerously close we came to a health system collapse. The Delta variant is more contagious and aggressive, and we are still learning about long-haul consequences from the virus. Political strategy and indecision could become the key determinants on how we will weather the next wave.

Preventable death and disability are not acceptable consequences. As the denominator of children with COVID-19 increases, so will the adverse outcomes – it’s simple but grim math. And those who could pay the biggest price will be our children. We need to step up and be the adults.

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